When considering the world's worst killers, alcohol likely doesn't come to mind. Yet alcohol kills more than 2.5 million people annually, more than AIDS, malaria or tuberculosis.
For middle-income people, who constitute half the world's population, alcohol is the top health risk factor, greater than obesity, inactivity and even tobacco.
The World Health Organization has meticulously documented the extent of alcohol abuse in recent years and has published solid recommendations on how to reduce alcohol-related deaths, but this doesn't go far enough, according to Devi Sridhar, a health-policy expert at the University of Oxford in the United Kingdom.
In a commentary appearing today (Feb. 15) in the journal Nature, Sridhar argues that the WHO should regulate alcohol at the global level, enforcing such regulations as a minimum drinking age, zero-tolerance drunken driving, and bans on unlimited drink specials. Abiding by the regulations would be mandatory for the WHO's 194 member states.
Far from prohibition, the WHO regulations would force nations to strengthen weak drinking laws and better enforce laws already in place, Sridhar says.
Approaching a bottle a day
Alcohol consumption is measured in terms of pure ethyl alcohol to compensate for the varying strengths of beer, wine and spirits. A liter bottle of wine with 10 percent alcohol, for example, would be only 0.1 liter of pure alcohol. According to the WHO, Americans each drink 9.4 liters of ethyl alcohol per year on average. That's equivalent to 94 bottles of the aforementioned wine. [See list of top 20 booze-consuming countries]
As high as that might sound, Americans don't even crack the top 50 on the world charts. Europe, in particular Eastern Europe, dominates the drinking scene. Moldova has the top drinkers, downing 18.4 liters of alcohol per capita yearly. That's equivalent to 184 1-liter bottles of wine, or nearly four bottles a week per person. The legal drinking age in Moldova is 16, and there are few restrictions on when or where alcohol can be sold.
The price of such alcohol abuse is early death. One in five men in the Russian Federation and neighboring European countries dies as a result of alcohol, according to WHO data. Alcohol abuse is associated with cardiovascular diseases, cirrhosis of the liver, various cancers, violence and vehicle accidents. Alcoholic adults have difficulty working and supporting their families, too.
Sobering recommendations
Sridhar argues that the WHO is unique among health organizations in that it can create legally binding conventions. The WHO has done this only twice in its 64-year history: the International Health Regulations, which require countries to report certain disease outbreaks and public-health events; and the Framework Convention on Tobacco Control, which commits governments to making legislative moves to reduce the demand for, and the supply of, tobacco.
No other entity can attack the global problem of alcohol abuse, she said. When it comes to alcohol, though, the WHO has settled on merely recommendations, such as those outlined in the 2010 WHO Global Strategy to Reduce Harmful Use of Alcohol.
"Countries are aware of the problem, but several haven't made a real commitment to implementing the recommendations," Sridhar told LiveScience. "The problem is not with ministries of health but with ministries of finance, trade, etc. who prioritize other interests first."
In her Nature commentary, Sridhar said that the existing WHO recommendations could serve as the framework for a new international convention on alcohol regulation. Yet even the United States would struggle to meet several of the 10 recommended target areas, which include advertising restrictions, price hikes and tougher laws against drunken driving.
"Ministries of health would have a stronger domestic negotiating position in prioritizing alcohol regulation above economic concerns," with the WHO muscle behind them, she wrote.
Alas, football ads might never be the same.
Correction: This article has been updated to correct Sridhar's affiliation, which should be the University of Oxford, not the University of Cambridge as had been stated.
Christopher Wanjek is the author of the books "Bad Medicine" and "Food At Work." His column, Bad Medicine, appears regularly on LiveScience.

Despite anything I may have said in any posts on this site that I'm a drinker. (like "Brrrrrp" or "I wote this last night after too many beer/margaretas, or whatever), I only drink 1 alcoholic drink ( a normal size, but very good, Margarita) a week normally. If I die from alcohol, it will have to be the result of somebody else's drunken driving. I hope that will never happen to me or anybody I know or love.

He forgot to mention running with scissors. That's a bad one too. And if we ever got that guy on a ski slope, that would be banned too.
Is laughter a bad one? Some don't like to hear certain kinds of laughing. Especially the ones that snort when they laugh. What about diving in the water instead of jumping?
Wait, didn't this all happen before. In my parents day they had Prohibition. Yeah, that one worked out well.

Cookie, did you post this because I mentioned "getting your drink on." in my video?
If you don't have sound on your computer, you need to get that fixed.

And let the guy buy you a Lexus, and a new computer. It's okay to receive too. The people that run the churches don't mind receiving, in fact they pass plates around for just that purpose. That's what I learn on Sunday. I see them driving nicer cars than I do.

I got sound now, only because I am sharing my son's computer while my other son is fixing mine. Wait, my son is sharing his computer, I am not sharing anything, lol. I usually don't watch the news on tv, I read my news, this way I can pick & choose over what I want to be depressed about, angered about, or laugh about. I was reading about the drinking I am not sure why I was, I just was. I thought of Ian... I will buy him a drink, if he is okay.

About the guy, lol, no, I don't want anything that splashy, or expensive, I am like I said, simple, my husband used to call me Popeye because, I always, always would say, " I yam what I yam." I make no pretenses, what you see, what you hear, is what I am. I can be silly, funny, sad, whiny, bossy, angry, loving, (sexy) creative, smart (almost intelligent), stupid (almost brain-dead), but above all, I am what I am. I make no apologies and offer no reasons, lol.

I say "you know" too much, I write, "lol" too much, and I love smiley faces, and sea world, ice cream cones, The Mr. Bean car, The Marx Brothers, Ma & Pa Kettle, and, I don't like, stuffy people, know it alls, those without a sense of humor or won't laugh at my jokes, or smile at my funny faces I can make, and relatives. And, some bosses. Most people,

I like to pay my own way, I am my own person, I belonged to NOW when they had a membership of 2. I yam what I yam.

I like my old car, my old computer, and red stiltettos.

...and some red wine.

I almost forgot... on that video, you looked pretty relaxed, lol. what were you drinking?

Well..........I had just gotten back from making the video at the club. It was two very nice pints of dark beer that tasted a bit like coffee. I wonder if Ian drinks stuff like that?
And yes, I was relaxed. That' may be why those words came out of my mouth like that.

The following newspaper aticle was written by Megan Ogilvie and is published in today's Toronto Star. It details some of the substance abuse problems on isolated reservations. Because the reservations are not accessible by road the problems are too easy to ignore:

The narcotic painkiller OxyContin will soon be pulled from ******** shelves across the country, and addiction experts warn the move will spark a public health crisis in Northern Ontario where thousands of people in remote communities face involuntary and potentially dangerous withdrawal from the addictive drug.

Purdue Pharma, the company that manufacturers OxyContin, is set to replace the controversial medication with a new formulation of the drug called OxyNEO at the end of February. The new drug is formulated in such a way that it is more difficult to crush, and therefore less likely to be abused through injecting or snorting.

Among the Nishnawbe Aski Nation, or NAN, which represents 49 First Nation communities in Northern Ontario, at least half of residents are addicted to OxyContin, said Grand Chief Stan Beardy.

“In some communities, it’s as high as 70 to 80 per cent of people addicted to OxyContin, including kids as young as 9 years old to people as old 65,” Beardy said.

“We are very concerned that if they cease manufacturing OxyContin and if there is no replacement or treatment or detox centres for these people, there is going to be a major catastrophe.”

He said health care in the communities is limited to nursing stations with visiting doctors coming to treat residents two or three days each month — not enough care to deal with the thousands of people who will be forced into withdrawal.

Benedikt Fischer, director of the Centre for Applied Research in Mental Health and Addictions at Vancouver’s Simon Fraser University, agrees the situation in Northern Ontario is dire.

“We are literally watching a public health catastrophe unfolding in slow motion,” he said, adding that the crisis is comparable to the spread of HIV among injection drug users in the 1980s and the overdose epidemic that hit Vancouver’s Downtown Eastside in the 1990s.

People forced off the powerful painkiller could replace it with heroin, crack cocaine and other dangerous drugs, and they will be more likely to inject drugs, increasing the spread of infectious diseases, said Fischer, who estimates 10,000 of the 45,000 NAN residents are addicted. And, he added, communities will likely see a spike in overdoses, a greater risk of miscarriage in pregnant women and a proliferation of crime.

On Thursday, Health Canada confirmed that as of Feb. 15 OxyContin had been pulled from the Non-Insured Health Benefits Program, which provides drug coverage for more than 800,000 registered First Nations and recognized Inuit.

However, a spokesperson for the agency said most of those addicted to OxyContin are not receiving the drug through government-funded legal prescriptions. Fewer than 100 NAN members get the drug paid for by the department, said Health Canada spokesperson Leslie Meerburg.

The Ontario Ministry of Health has not yet said how it will fund OxyNEO, nor is it clear how much OxyContin is stockpiled in the province.

“There is little concern of withdrawal for clients switching therapy from OxyContin to OxyNeo when taken as prescribed by a physician,” she said. “However, it is possible that some clients who obtained OxyContin through other sources may go into withdrawal when OxyContin is removed from the Canadian market and they are unable to find another source of supply.

“This is a concern for any individual who obtains and uses OxyContin outside of appropriate medical indications.”

Grand Chief Beardy acknowledged the vast majority of OxyContin abused by NAN residents is sold on the black market, with individual pills selling for between $300 and $600.

The potent painkiller has helped fuel an epidemic of opioid addiction in Canada. In Ontario, the rate of deaths involving narcotic painkillers went from 13.7 per million in 1991 to 27.2 per million in 2004.

On Feb. 6, the Cat Lake First Nation declared a state of emergency because 70 per cent of residents were addicted to OxyContin.

Beardy said he and others have called on the federal and provincial governments for help, but have received little response.

Fischer said an emergency program needs to be put in place. Ideally, the rapid launch of prevention and treatment interventions should include, among other things, needle exchange programs to prevent the spread of infectious disease and providing addicts with substitution drugs, such as methadone or suboxone.

“We need to find ways to get these treatments to these communities as widely and effectively as possible,” he said.

Health Canada said the NIHB program covers methadone and suboxone, but recognizes that access to the drugs is a “significant issue” for those in remote locations.

“In such instances, the NIHB Program reviews requests from health providers on a case-by-case basis and will provide coverage for suboxone to help ensure First Nations clients have access to this drug without leaving their community,” Meerburg said.

I specifically asked my doctors in November to not prescribe OxyContin for pain relief while I was in the hospital. He heard that I didn't want it, and he gave it to me anyway. I lasted about 20 hours on the stuff before I demanded that the nurse switch me over to something else. It does not play nice. I don't like what it does at all. And I have always wondered why it was a first choice when there are other meds that work with so much fewer problems. I hated the stuff in 2010 and asked for a different product then. It sucks.

Dilaudid or Hydromorphone is a much nicer product, at least for me. This last November, the surgeon did a good enough job that I only used it for two weeks after a major surgery and I was done. And then the rest was put in the trash. I hate pills.

In answer to your question Terry, about why it was and is a first choice in hospitals, the reason is simply, it is cost effective. Some people don't want to hear the truth about stuff, but, when dealing with insurance companies, it is money first, patient second. There are many times, the doctors know, something will work better and be easier on the patient, especially, when something is long-term, but, their are many times doctors won't tell you things because, simply, Terry, they make money on certain things. Like for instance, Terry, certain "trials" will pay an onc as much as 5 grand to get someone to enter into it. And, trials, are crapshoots. Even with GP's if they scribe, certain meds, it is cost effective to them. Some people don't want to know the truth when they adore their doctor, but, doctors are people, too. And, human. It is what it is. People need to be more verbal on things, especially, meds when they downright know, they experience unpleasant side effects. I can't take codeine, and a variety of things, it really tears my stomach apart, and I am verbal about it. No thanks... I hand the script back, with a smile, but, I hand it back. Bottom line, is, you got one life to live, live it well, and to your expectations.

In answer to your question Terry, about why it was and is a first choice in hospitals, the reason is simply, it is cost effective. Some people don't want to hear the truth about stuff, but, when dealing with insurance companies, it is money first, patient second. There are many times, the doctors know, something will work better and be easier on the patient, especially, when something is long-term, but, their are many times doctors won't tell you things because, simply, Terry, they make money on certain things. Like for instance, Terry, certain "trials" will pay an onc as much as 5 grand to get someone to enter into it. And, trials, are crapshoots. Even with GP's if they scribe, certain meds, it is cost effective to them. Some people don't want to know the truth when they adore their doctor, but, doctors are people, too. And, human. It is what it is. People need to be more verbal on things, especially, meds when they downright know, they experience unpleasant side effects. I can't take codeine, and a variety of things, it really tears my stomach apart, and I am verbal about it. No thanks... I hand the script back, with a smile, but, I hand it back. Bottom line, is, you got one life to live, live it well, and to your expectations.

BUT, I am editing this to add something really important regarding this for those reading who maybe, is contemplating a trial. Many trials can and are good trials, ESPECIALLY, for those who are running out of options, who taking an experimental, previously, untested drug could be of benefit. Those types of trials, are ones where you DO NOT get a placebo. You will actually, be getting a possible life-saving drug.

And, I believe doing your homework, being your own best friend and advocate is just as important as any drug you could get. It is important to ask questions. ASK, if the oncologist is getting paid for you enlisting into the trial, and my advice is, to get a second opinion if the answer is yes. THAT is just my opinion. Don't think for a second the oncologist wouldn't be asking questions if he was the patient. Trials can be good, trials can be bad. I personally, wouldn't want to end up with a placebo, and there, are those where you do not know if you are or not. Those trials are usually, for those in earlier stages, it is just my opinion that I want the real deal.

I tell the doctors, what I want. Drugs, tests, etc. I am not shy about wanting to live a good long life. I can't take certain medications and there is no way, I would take certain drugs and suffer because someone wants me to take something, when, there are other options, other medications. I would make myself heard.

Certainly seems like a better idea to subsidize bud light for the Indians than to make them into criminal zombies by snorting powdered pain killers and airplane glue. When you are on the dole in a place with 3 hours of sunlight, and no need to hunt moose anymore, you get a bit bored.

Walmart almost killed my father.....filled the wrong prescription. They gave him somthing he wasn't even prescribed and it was a drug to lower blood pressure. He basically overdosed on blood pressure medicine......so bad the Dr. first thought his equipment was BROKEN.

I hope your dad is going to be okay. I don't much like Walmart for much of anything, not my kind of store. I agree we all are human and make mistakes, but, then, I feel we must be accountable for those mistakes. I truly do.

To say a remark like that is minimizing what they did wrong. It is wrong.

If not his kids are going to be very rich indeed. Maybe so even of he lives, with a good lawyer.

I feel like Im going to get TB or Ebola virus when I rub up with some of the zombies at the local wallyworld. Looks like the bar scene in 'Starwars'....Pretty much have decided the big boxes are totally dehumanizing, and only go for a very particular need.